心脏再同步治疗除颤器植入后预测结果:心脏再同步疗法除颤器Futility评分

B. Maille, A. Bodin, A. Bisson, J. Herbert, B. Pierre, N. Clementy, Victor Klein, F. Franceschi, J. Deharo, L. Fauchier
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引用次数: 3

摘要

背景心脏再同步治疗(CRT)除颤器(CRT-D)相对于CRT起搏器的风险效益仍然存在争议。我们的目标是在1 CRT-D植入的年份,并制定CRT-D功能评分。方法基于行政出院数据库,纳入法国(2010-2019年)所有接受预防性CRT-D植入治疗的连续患者。通过分样本验证,推导并验证了CRT-D植入后1年全因死亡的预测模型(被认为是徒劳的)。结果23 029名患者(平均年龄68±10岁;4873名(21.2%)女性),记录了7016例死亡(年发病率7.2%),其中1604例(22.8%)发生在 CRT-D植入年份。在衍生队列中(n=11 514),最终的逻辑回归模型包括——作为无效的主要预测因素——老年、糖尿病、二尖瓣反流、主动脉狭窄、心力衰竭住院史、肺水肿史、心房颤动史、肾病、肝病、营养不良和贫血。CRT-D无效性评分的曲线下面积在推导队列中为0.716(95%置信区间:0.698至0.734),在验证队列中为0.692(0.673至0.710)。Hosmer-Lemeshow检验的p值为0.57,表明校准准确。CRT-D无效性得分在识别无效性方面优于Goldenberg和EAARN得分。根据CRT-D无效性评分,15.9%的患者被归类为高危患者(预测无效性为16.6%)。
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Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the cardiac resynchronisation therapy defibrillator Futility score
Background Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score. Methods Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010–2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. Results Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included—as main predictors of futility—older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%). Conclusions The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.
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